Shoulder Basics

Mechanical Problems of the Shoulder
Mechanical problems of the shoulder are common. They are often revealed by the answers to some simple questions:

  • Is the shoulder stiff? Can the arm be put in all normal positions?
  • Is the shoulder unstable? Does it feel like it is going to pop out or slide out of the socket?
  • Is the shoulder weak? Does it have the strength to carry out desired activities?
  • Is the shoulder rough? Does it catch and grind with use?

Non-Mechanical Problems of the Shoulder
There is another group of shoulder problems which is not related to shoulder mechanics. These include conditions such as arthritis of the neck, nerve irritation, bone infection, bone tumors, and various pain syndromes. These conditions typically produce pain whether or not the shoulder is being used. Persistent non-mechanical problems of the shoulder require a thorough evaluation which is not covered here.

Quick guide to the evaluation and management of shoulder problems
Unless there has been a major traumatic injury or evidence of infection, there is time for the ‘basic approach’ listed below.

I. History
Date and circumstances of onset
Previous treatment
Factors that aggravate

II. Exam
Is the shoulder stiff?
Is the shoulder unstable?
Is the shoulder weak?
Is the shoulder rough?

III. Radiographs
The two key xrays to take are the AP in the plane of the scapula and the axillary lateral. These will show arthritis or may suggest instability. See the image:

IV. Initial management of shoulder problems that are not fractures or infections includes non-narcotic analgesics and gentle exercises that the patient can perform themselves. 

A. Exercises for the stiff shoulder
B. Exercises for the unstable shoulder
C. Exercises for the weak shoulder 
D. Exercises for the rough shoulder

Scapula and the Axillary Lateral
(click to enlarge)